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General NPI Number Information
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NPI Number | 1881567410
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Entity Type | Organization
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Legal Business Name | JUST A POKE MOBILE LABS LLC
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 118 OHIO AVE N STE A
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City | LIVE OAK
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State | FL
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Zip | 32064-2464
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Country | US
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Telephone | 904-884-9380
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Fax |
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Provider Business Mailing Address
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Address Line | 3592 198TH ST
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City | WELLBORN
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State | FL
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Zip | 32094-3453
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Country | US
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Telephone | 904-884-9380
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAYLOR C BURKER
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Credential |
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Telephone | 904-884-9380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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